Presentation on theme: "CT - Anatomy and Pathology of Uterus and Ovaries"— Presentation transcript:
1 CT - Anatomy and Pathology of Uterus and Ovaries Migdalia OrdonezOHSUSummer 2012
2 Purpose of this Presentation Review Pelvic anatomy on CT.Review common Pelvic pathologies on CT.
3 Topics to review: (use hyperlinks to jump to different sections) CT basicsNormal AnatomyNon-neoplasmNeoplasms
4 CT basicsNormal AnatomyNon-neoplasmNeoplasmFirst, some basic CT Principles you will need for this learning module.
5 View the image is as if you were looking up from the patient’s feet. CT basicsNormal AnatomyNon-neoplasmNeoplasmCT BasicsRightLeftView the image is as if you were looking up from the patient’s feet.
6 CT Basics > > > > Normal AnatomyNon-neoplasmNeoplasmCT Basics>>>>Metal Bone Water Fat Air (tissue and blood)+500 to HU to -500 HU HU to -50 HU to HUThings appear whiter according to their relative densities.This property is called “Attenuation” and it is quantified in Hounsfield Units (HU), which can be measured on CT viewing software.
7 Quick review Is it metal, bone, water, fat, or air A. _______ CT basicsNormal AnatomyNon-neoplasmNeoplasmQuick reviewIs it metal, bone, water, fat, or airA. _______B. _______C. _______D. _______C.D.B.A.
8 Answers Is it metal, bone, water, fat, or air A. Muscle B. Bone C. Air CT basicsNormal AnatomyNon-neoplasmNeoplasmAnswersIs it metal, bone, water, fat, or airA. MuscleB. BoneC. AirD. FatC.D.B.A.
9 Normal Pelvic Anatomy Uterus Ovary CT basics Normal Anatomy Non-neoplasmNeoplasmNormal Pelvic AnatomyUterusOvary
10 Identify structures in next slide: CT basicsNormal AnatomyNon-neoplasmNeoplasmIdentify structures in next slide:
11 CT basicsNormal AnatomyNon-neoplasmNeoplasmIdentify structures Landmarks: Ovaries usually lateral to uterus and inferior to bifurcation of Iliac vessels CABCDEFG
12 Identify structures A B C D E F G Bladder Piriformis muscle CT basicsNormal AnatomyNon-neoplasmNeoplasmIdentify structuresABCDEFGBladderPiriformis muscleRight ovaryRectumLeft ureterPsoas muscleUterine body
14 Side note: This is a… Hysterosalpingogram CT basicsNormal AnatomyNon-neoplasmNeoplasmSide note: This is a…HysterosalpingogramRadio-opaque material is injected into the cervical canal.Procedure is used to investigate the shape of uterine cavity and shape and patency of fallopian tubes.Included here to review anatomy
16 Pathology – Non-neoplasm CT basicsNormal AnatomyNon-neoplasmNeoplasmPathology – Non-neoplasmDescribe what you see:Attenuation (density)Heterogeneous v. HomogenousWell-circumscribed v. Indistinct BordersEnhancing (lights up with contrast) v. non-enhancingLocation
17 CT basicsNormal AnatomyNon-neoplasmNeoplasmCase #128 year old female presents with fever, lower abdominal pain, new vaginal discharge and complaints of painful intercourse.Physical exam: Febrile and cervical motion tenderness.A computed tomography (CT) was done, see next slide.
18 CT basicsNormal AnatomyNon-neoplasmNeoplasmDescribe what you see:
19 Pelvic Inflammatory Disease CT basicsNormal AnatomyNon-neoplasmNeoplasmEnlarged uterus of soft-tissue attenuation, flanked at the posterior aspects by tortuous, thick-walled oviduct Left greater than Right filled with material of fluid-attenuation.Pelvic Inflammatory Disease
20 CT basicsNormal AnatomyNon-neoplasmNeoplasmCase #236 year old female presents with sudden onset bilateral pelvic pain, left side worse than right. History of pelvic inflammatory disease a year ago treated with antibiotics.Physical exam: Tender to palpation in bilateral lower abdomen, L greater than R. Entire pelvis tender to palpation.A computed tomography (CT) was done, see next slide.
21 CT basicsNormal AnatomyNon-neoplasmNeoplasmDescribe what you see:
22 Coronal view - Describe what you see: CT basicsNormal AnatomyNon-neoplasmNeoplasmCoronal view - Describe what you see:
23 CT basicsNormal AnatomyNon-neoplasmNeoplasmLeft pelvis there is a cystic lesion with heterogeneous enhancement.The lesion appears to be contiguous with the uterus, likely representing…Tubo-ovarian abscess
25 CT basicsNormal AnatomyNon-neoplasmNeoplasmCase #323 year old female presents with fever, chills, lower abdominal pain, recent history of PID treated with antibiotics.Physical exam: Febrile and cervical motion tenderness.A computed tomography (CT) was done, see next slide.
26 CT basicsNormal AnatomyNon-neoplasmNeoplasmDescribe what you see:
27 CT basicsNormal AnatomyNon-neoplasmNeoplasmUterus has large, heterogeneous mass with areas of soft-tissue attenuation and areas of fluid attenuationTubo-ovarian abscess
28 CT basicsNormal AnatomyNon-neoplasmNeoplasmCase #423 year old female presents to ED by ambulance due to motor vehicle accident. She is complaining of lower abdominal / pelvic pain.Physical exam: Pelvis tender to palpation.A computed tomography (CT) was done, see next slide.
29 CT basicsNormal AnatomyNon-neoplasmNeoplasmDescribe what you see:
30 IUD Highly attenuated object in uterus, otherwise normal pelvic CT CT basicsNormal AnatomyNon-neoplasmNeoplasmHighly attenuated object in uterus, otherwise normal pelvic CTIUD
31 CT basicsNormal AnatomyNon-neoplasmNeoplasmCase #521 year old female with 2 days of progressively worsening pelvic pain. She missed last period. She has been feeling nauseated for past 3 weeks.Physical exam: right pelvic tenderness, breast tenderness.A computed tomography (CT) was done, see next slide.
32 CT basicsNormal AnatomyNon-neoplasmNeoplasmDescribe what you see:
33 Contrast enhanced axial CT image shows strong enhancing ring-like mass (arrow) that represents gestational sac without hemoperitoneumCT basicsNormal AnatomyNon-neoplasmNeoplasmEctopic pregnancy
34 Pathology - Neoplasm Describe what you see: Attenuation (density) CT basicsNormal AnatomyNon-neoplasmNeoplasmPathology - NeoplasmDescribe what you see:Attenuation (density)Heterogeneous v. HomogenousWell-circumscribed v. Indistinct BordersEnlarged v. atrophiedEnhancing (lights up with contrast) v. non-enhancingLocation
35 CT basicsNormal AnatomyNon-neoplasmNeoplasmCase #613 year old female presents with abdominal discomfort and feeling bloated. Stomach seems to be growing wider.Physical exam: Increased abdominal girthA computed tomography (CT) was done, see next slide.
36 CT basicsNormal AnatomyNon-neoplasmNeoplasmDescribe what you see:
37 (Mature dermatoid cyst) CT basicsNormal AnatomyNon-neoplasmNeoplasmMid pelvis there is large, thin-walled, cystic structure of fluid-attenuation.At the periphery of this structure are a few distinct regions of heterogeneous tissue.Within the right lateral aspect lies a foci of bone-density material.Within the left lateral aspect lies a heterogeneous foci of fat and soft-tissue densitiesTeratoma(Mature dermatoid cyst)
38 CT basicsNormal AnatomyNon-neoplasmNeoplasmCase #748 year old female was involved in motor vehicle accident. She is shaken up from accident but otherwise feeling fine.Physical exam: Pt is in no acute distress. No signs or symptoms of pain. Patient insisted having a CT to rule out bleeds.A computed tomography (CT) was done, see next slide.
39 Describe what you see: Clue: this arises from the ovary CT basics Normal AnatomyNon-neoplasmNeoplasmDescribe what you see:Clue: this arises from the ovary
40 Serous Cystadenoma (benign) CT basicsNormal AnatomyNon-neoplasmNeoplasmPosterior aspect of the pelvis lies a well-circumscribed, thin-walled, non-septated cystic structure containing fluid-density materialClue: this arises from the ovarySerous Cystadenoma(benign)Incidental finding on CT
41 CT basicsNormal AnatomyNon-neoplasmNeoplasmCase #858 year old female presents to clinic with bloating, back pain, urinary urgency, constipation, and tiredness for 6 months. Recently she developed pelvic pain, vaginal bleeding, and unintentional weight loss.Physical exam: Abdomen tender to palpation throughout. Pelvic tenderness.A computed tomography (CT) was done, see next slide.
42 Describe what you see: Clue: This arises from the ovary CT basics Normal AnatomyNon-neoplasmNeoplasmDescribe what you see:Clue: This arises from the ovary
43 Cystadenocarcinoma (Malignant) CT basicsNormal AnatomyNon-neoplasmNeoplasmThe pelvic cavity is grossly distended by multiple well-circumscribed, thin-walled, septated, lobular structures of fluid-density.These structures are compressing but don’t seem to invade surrounding pelvic tissuesCystadenocarcinoma(Malignant)Note: Septations and lobulated surface
44 Sources As well as IMPAX, EPIC, and WIKIPEDIA CT basics Normal Anatomy Non-neoplasmNeoplasmSourcesSiddall KA. Multidetector CT of the female pelvis. Radiol Clin North Am. 01-NOV-2005; 43(6):Casillas J, Joseph RC, Guerra JJ Jr. CT appearance of uterine leiomyomas. Radiographics Nov;10(6):Foshager MC, Walsh JW. CT anatomy of the female pelvis: a second look. Radiographics Jan;14(1):51-64;Outwater EK, Siegelman ES, Hunt JL. Ovarian teratomas: tumor types and imaging characteristics. Radiographics Mar-Apr;21(2):Pannu, HK, et al. MD CT Evaluation of Cervical Cancer: Spectrum of Disease. Radiographics 2001; 21:1155–1168Rha SE, et al. CT and MR imaging features of adnexal torsion. Radiographics Mar-Apr;22(2):Roberts JL, Dalen K, Bosanko CM, Jafir SZ. CT in abdominal and pelvic trauma. Radiographics Jul;13(4):Roobolamini, SA. Imaging of Pregnancy-related Complications. Radiographics 1993; 13:Saksouk FA, Johnson SC. Recognition of the ovaries and ovarian origin of pelvic masses with CT. Radiographics Oct;24 Suppl 1:SSam JW, Jacobs JE, Birnbaum BA. Spectrum of CT findings in acute pyogenic pelvic inflammatory disease. Radiographics Nov-Dec;22(6):Yang DM. Retroperitoneal cystic masses: CT, clinical, and pathologic findings and literature review. Radiographics Sep-Oct;24(5):Buy, J-N, et al. Cystic Teratoma of the Ovary: CT Detection. Radiology 1989; 171:As well asIMPAX, EPIC, and WIKIPEDIA